GEORGETTE REVIEW PMHNP EXAM Questions & Answers
(Verified 2026) Complete Psychiatric Mental Health Nurse
Practitioner Board Review
Pass your ANCC psychiatric-mental health nurse practitioner boards on your very first
try with this definitive 2026/2027 Georgette Review PMHNP practice exam bank. This
comprehensive preparation guide features high-yield exam questions paired with 100%
verified answers and rigorous clinical rationales covering advanced
psychopharmacology, DSM-5-TR diagnostic criteria, neurobiology, and
psychotherapeutic modalities. It is an indispensable resource for graduate nursing
students looking to streamline their study routines, build absolute clinical diagnostic
confidence, and secure a passing score.
1. A 32-year-old female with bipolar I disorder is maintained on lithium 900 mg
daily. She presents with nausea, vomiting, coarse hand tremors, and ataxia. Her
serum lithium level is 2.1 mEq/L. Which of the following concurrent medications
most likely contributed to this toxicity?
A) Acetaminophen 500 mg daily
B) Ibuprofen 600 mg three times daily for menstrual cramps
C) Omeprazole 20 mg daily
D) Cetirizine 10 mg daily
Correct Answer: B) Ibuprofen 600 mg three times daily for menstrual cramps
Rationale: NSAIDs (ibuprofen, naproxen) decrease renal blood flow and reduce lithium
clearance, leading to elevated serum lithium levels and toxicity. Symptoms of toxicity
include nausea, vomiting, coarse tremors, ataxia, confusion, and diarrhea. Acetaminophen
is safer with lithium. Omeprazole and cetirizine do not significantly affect lithium levels.
2. A 16-year-old male is brought to the clinic by his parents due to a 6-month
history of persistent angry outbursts, arguing with authority figures, and
vindictiveness toward his younger brother. He does not violate rules outside the
home. Which diagnosis is MOST consistent with this presentation?
A) Conduct Disorder
B) Oppositional Defiant Disorder
C) Intermittent Explosive Disorder
D) Disruptive Mood Dysregulation Disorder
,Correct Answer: B) Oppositional Defiant Disorder
Rationale: ODD is characterized by a pattern of angry/irritable mood,
argumentative/defiant behavior, and vindictiveness lasting at least 6 months. Unlike
Conduct Disorder, ODD does not involve serious violations of others' rights or societal
norms. The patient's behaviors are confined to authority figures within the home setting.
3. A 28-year-old female reports excessive worry about having a serious
undiagnosed illness despite multiple normal physical examinations and laboratory
results. She spends hours researching symptoms online and frequently visits
emergency departments. She has minimal somatic symptoms. What is the MOST
appropriate diagnosis?
A) Somatic Symptom Disorder
B) Illness Anxiety Disorder
C) Conversion Disorder
D) Factitious Disorder
Correct Answer: B) Illness Anxiety Disorder
Rationale: Illness Anxiety Disorder is characterized by preoccupation with having or
acquiring a serious illness, with minimal or no somatic symptoms present. Health-related
anxiety is excessive, and the patient frequently seeks medical reassurance. Somatic
Symptom Disorder involves one or more somatic symptoms that are distressing or
disruptive to daily life, along with excessive thoughts, feelings, or behaviors related to the
symptoms.
4. A 45-year-old male with schizophrenia has been on clozapine for 6 months. His
recent ANC is 850 cells/mm³. What is the MOST appropriate next step?
A) Continue clozapine and monitor weekly
B) Discontinue clozapine immediately and contact the prescriber
C) Decrease the clozapine dose by 50%
D) Add lithium to increase WBC count
Correct Answer: B) Discontinue clozapine immediately and contact the prescriber
Rationale: Clozapine should be discontinued if ANC falls below 1000 cells/mm³. Patients
must be enrolled in the Clozapine REMS program with regular ANC monitoring. Severe
neutropenia (ANC <500) is a medical emergency. Holding clozapine and contacting the
provider for further management is essential.
,5. Which of the following brain regions is MOST associated with fear, anxiety, and
emotional memory?
A) Hippocampus
B) Amygdala
C) Thalamus
D) Hypothalamus
Correct Answer: B) Amygdala
Rationale: The amygdala is responsible for emotional processing, particularly fear, anxiety,
and emotional memory. It is a key structure in the limbic system and plays a central role
in the stress response. The hippocampus is involved in memory consolidation and
emotional regulation. The thalamus relays sensory information, and the hypothalamus
regulates autonomic functions and appetite.
6. A 55-year-old female with Alzheimer's disease is being treated with donepezil.
Which neurotransmitter system is primarily targeted by this medication?
A) Dopamine
B) Acetylcholine
C) Serotonin
D) Glutamate
Correct Answer: B) Acetylcholine
Rationale: Donepezil is a cholinesterase inhibitor that increases acetylcholine levels in the
synaptic cleft by inhibiting acetylcholinesterase. Alzheimer's disease is associated with
cholinergic neuron degeneration in the basal nucleus of Meynert. Donepezil is FDA-
approved for mild, moderate, and severe Alzheimer's disease.
7. A 22-year-old female with a history of bulimia nervosa reports recurrent
episodes of binge eating followed by self-induced vomiting. She is at risk for
which of the following electrolyte imbalances?
A) Hyperkalemia
B) Hypokalemia
C) Hypernatremia
D) Hypocalcemia
Correct Answer: B) Hypokalemia
, Rationale: Bulimia nervosa with self-induced vomiting can cause hypokalemia due to loss
of potassium in gastric secretions. Patients are also at risk for metabolic alkalosis,
dehydration, and dental erosion. Hypokalemia can lead to cardiac arrhythmias and
requires monitoring.
8. A 60-year-old male with a history of alcohol use disorder is started on
disulfiram. He is instructed to avoid all alcohol-containing products, including
which of the following?
A) Fruit juice
B) Mouthwash and cough syrup
C) Carbonated beverages
D) Herbal teas
Correct Answer: B) Mouthwash and cough syrup
Rationale: Disulfiram inhibits aldehyde dehydrogenase, causing accumulation of
acetaldehyde when alcohol is consumed. Patients must avoid all alcohol-containing
products, including mouthwash, cough syrup, aftershave, cooking wines, and certain foods.
The reaction includes flushing, nausea, vomiting, and tachycardia.
9. A 40-year-old male with treatment-resistant depression is started on an MAOI.
Which of the following dietary restrictions is MOST important to prevent a
hypertensive crisis?
A) Limiting caffeine intake
B) Avoiding tyramine-rich foods
C) Increasing salt intake
D) Avoiding artificial sweeteners
Correct Answer: B) Avoiding tyramine-rich foods
Rationale: MAOIs combined with tyramine-rich foods (aged cheeses, cured meats,
fermented foods, red wine, draft beer) can cause a hypertensive crisis. Tyramine is
normally metabolized by MAO; when MAO is inhibited, tyramine accumulates and
releases norepinephrine, causing dangerous hypertension.
10. A 50-year-old female with bipolar disorder is started on valproic acid. Which
baseline laboratory test is ESSENTIAL before starting this medication?
A) Complete blood count
B) Liver function tests
(Verified 2026) Complete Psychiatric Mental Health Nurse
Practitioner Board Review
Pass your ANCC psychiatric-mental health nurse practitioner boards on your very first
try with this definitive 2026/2027 Georgette Review PMHNP practice exam bank. This
comprehensive preparation guide features high-yield exam questions paired with 100%
verified answers and rigorous clinical rationales covering advanced
psychopharmacology, DSM-5-TR diagnostic criteria, neurobiology, and
psychotherapeutic modalities. It is an indispensable resource for graduate nursing
students looking to streamline their study routines, build absolute clinical diagnostic
confidence, and secure a passing score.
1. A 32-year-old female with bipolar I disorder is maintained on lithium 900 mg
daily. She presents with nausea, vomiting, coarse hand tremors, and ataxia. Her
serum lithium level is 2.1 mEq/L. Which of the following concurrent medications
most likely contributed to this toxicity?
A) Acetaminophen 500 mg daily
B) Ibuprofen 600 mg three times daily for menstrual cramps
C) Omeprazole 20 mg daily
D) Cetirizine 10 mg daily
Correct Answer: B) Ibuprofen 600 mg three times daily for menstrual cramps
Rationale: NSAIDs (ibuprofen, naproxen) decrease renal blood flow and reduce lithium
clearance, leading to elevated serum lithium levels and toxicity. Symptoms of toxicity
include nausea, vomiting, coarse tremors, ataxia, confusion, and diarrhea. Acetaminophen
is safer with lithium. Omeprazole and cetirizine do not significantly affect lithium levels.
2. A 16-year-old male is brought to the clinic by his parents due to a 6-month
history of persistent angry outbursts, arguing with authority figures, and
vindictiveness toward his younger brother. He does not violate rules outside the
home. Which diagnosis is MOST consistent with this presentation?
A) Conduct Disorder
B) Oppositional Defiant Disorder
C) Intermittent Explosive Disorder
D) Disruptive Mood Dysregulation Disorder
,Correct Answer: B) Oppositional Defiant Disorder
Rationale: ODD is characterized by a pattern of angry/irritable mood,
argumentative/defiant behavior, and vindictiveness lasting at least 6 months. Unlike
Conduct Disorder, ODD does not involve serious violations of others' rights or societal
norms. The patient's behaviors are confined to authority figures within the home setting.
3. A 28-year-old female reports excessive worry about having a serious
undiagnosed illness despite multiple normal physical examinations and laboratory
results. She spends hours researching symptoms online and frequently visits
emergency departments. She has minimal somatic symptoms. What is the MOST
appropriate diagnosis?
A) Somatic Symptom Disorder
B) Illness Anxiety Disorder
C) Conversion Disorder
D) Factitious Disorder
Correct Answer: B) Illness Anxiety Disorder
Rationale: Illness Anxiety Disorder is characterized by preoccupation with having or
acquiring a serious illness, with minimal or no somatic symptoms present. Health-related
anxiety is excessive, and the patient frequently seeks medical reassurance. Somatic
Symptom Disorder involves one or more somatic symptoms that are distressing or
disruptive to daily life, along with excessive thoughts, feelings, or behaviors related to the
symptoms.
4. A 45-year-old male with schizophrenia has been on clozapine for 6 months. His
recent ANC is 850 cells/mm³. What is the MOST appropriate next step?
A) Continue clozapine and monitor weekly
B) Discontinue clozapine immediately and contact the prescriber
C) Decrease the clozapine dose by 50%
D) Add lithium to increase WBC count
Correct Answer: B) Discontinue clozapine immediately and contact the prescriber
Rationale: Clozapine should be discontinued if ANC falls below 1000 cells/mm³. Patients
must be enrolled in the Clozapine REMS program with regular ANC monitoring. Severe
neutropenia (ANC <500) is a medical emergency. Holding clozapine and contacting the
provider for further management is essential.
,5. Which of the following brain regions is MOST associated with fear, anxiety, and
emotional memory?
A) Hippocampus
B) Amygdala
C) Thalamus
D) Hypothalamus
Correct Answer: B) Amygdala
Rationale: The amygdala is responsible for emotional processing, particularly fear, anxiety,
and emotional memory. It is a key structure in the limbic system and plays a central role
in the stress response. The hippocampus is involved in memory consolidation and
emotional regulation. The thalamus relays sensory information, and the hypothalamus
regulates autonomic functions and appetite.
6. A 55-year-old female with Alzheimer's disease is being treated with donepezil.
Which neurotransmitter system is primarily targeted by this medication?
A) Dopamine
B) Acetylcholine
C) Serotonin
D) Glutamate
Correct Answer: B) Acetylcholine
Rationale: Donepezil is a cholinesterase inhibitor that increases acetylcholine levels in the
synaptic cleft by inhibiting acetylcholinesterase. Alzheimer's disease is associated with
cholinergic neuron degeneration in the basal nucleus of Meynert. Donepezil is FDA-
approved for mild, moderate, and severe Alzheimer's disease.
7. A 22-year-old female with a history of bulimia nervosa reports recurrent
episodes of binge eating followed by self-induced vomiting. She is at risk for
which of the following electrolyte imbalances?
A) Hyperkalemia
B) Hypokalemia
C) Hypernatremia
D) Hypocalcemia
Correct Answer: B) Hypokalemia
, Rationale: Bulimia nervosa with self-induced vomiting can cause hypokalemia due to loss
of potassium in gastric secretions. Patients are also at risk for metabolic alkalosis,
dehydration, and dental erosion. Hypokalemia can lead to cardiac arrhythmias and
requires monitoring.
8. A 60-year-old male with a history of alcohol use disorder is started on
disulfiram. He is instructed to avoid all alcohol-containing products, including
which of the following?
A) Fruit juice
B) Mouthwash and cough syrup
C) Carbonated beverages
D) Herbal teas
Correct Answer: B) Mouthwash and cough syrup
Rationale: Disulfiram inhibits aldehyde dehydrogenase, causing accumulation of
acetaldehyde when alcohol is consumed. Patients must avoid all alcohol-containing
products, including mouthwash, cough syrup, aftershave, cooking wines, and certain foods.
The reaction includes flushing, nausea, vomiting, and tachycardia.
9. A 40-year-old male with treatment-resistant depression is started on an MAOI.
Which of the following dietary restrictions is MOST important to prevent a
hypertensive crisis?
A) Limiting caffeine intake
B) Avoiding tyramine-rich foods
C) Increasing salt intake
D) Avoiding artificial sweeteners
Correct Answer: B) Avoiding tyramine-rich foods
Rationale: MAOIs combined with tyramine-rich foods (aged cheeses, cured meats,
fermented foods, red wine, draft beer) can cause a hypertensive crisis. Tyramine is
normally metabolized by MAO; when MAO is inhibited, tyramine accumulates and
releases norepinephrine, causing dangerous hypertension.
10. A 50-year-old female with bipolar disorder is started on valproic acid. Which
baseline laboratory test is ESSENTIAL before starting this medication?
A) Complete blood count
B) Liver function tests
